3 things to know about crown placement
Pre-formed metal crowns, like any procedure, come with risks.
You need to understand what these are so that you can plan and consent patients appropriately. This is a very safe treatment overall, so no need to scare patients!
1. Appearance
Probably the biggest disadvantage to pre-formed metal crowns is the appearance. There are techniques to make them look better (eg pre-veneered crowns), but these tend not to work.
Usually, we find it’s best to be upfront about this, make sure parents and children understand what they look like, explain that the evidence is good and that they will work well. Children are usually OK with them, so it’s the parents you need to convince.
Issues tend to arise when families aren’t shown the crowns before they are fitted, so the key here is taking good consent and recording that the appearance has been discussed. This is particularly important before treatment under general anaesthetic when often a lot of care is provided but the parent or guardian is not present at the time.
2. Managing a tooth that becomes non-vital after crown placement.
This is a risk with any restoration, and arguably it is probably less following crown placement. If it does happen, there is no reason why the tooth can’t be extracted or a pulpectomy be carried out through the crown.
Where this can get complicated is planning a child for treatment under general anaesthetic (GA) who has Hall crowns placed already. Do you leave them on? Take the teeth out? There is no absolute answer — it will depend on the extent of caries under these pre-existing crowns. You need to work out how you will assess that.
Either you will know (because you placed the Hall crown), or you can figure it out by taking x-rays, or by actually removing the Hall crowns under the GA.
3. First permanent molar impaction.
Sometimes first permanent molars become impacted on the second primary molar. This can happen with or without a crown on the second primary molar. If you think the crown might be obstructing the eruption of the first permanent molar, then remove it.
If you’d like to learn more about dentistry for non-specialists, check out the online course, from UCL, below.
Paediatric Dentistry for Non-Specialists
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